Beyond Birth Questionnaire

This form is to help me get to know you and your family a bit better. There is no pressure to share anything you don’t want to, and all questions are optional except for contact information.

All responses and information shared during our discussions are strictly confidential and all paperwork including this completed form are kept in accordance with GDPR regulations. Please complete and return this form a minimum of 24 hours before your first session to enable me time to prepare for our time together. If you experience any issues with this form, please email me at info@themilkhub.co.uk

Your name *

First

Last

What are your preferred pronouns for yourself and your family?

Your email address *

Your telephone number *

Do you give consent to be added to the course Whats App group?

Your address

What are the names and ages of your children?

What is the name of your partner/supporter?

First

Last

What is your relationship to your named partner/supporter?

E.g. husband, wife, partner, friend, parent, etc.

What motivated you to join the Beyond Birth classes?

Can you tell us a little about your parenting journey so far? This may include details of your birth experience, feeding journey, how you've been feeling. Anything that you would like to share with us!

Are you familiar with mindfulness techniques and do you use them regularly?

Have you been ever been diagnosed with any mental health conditions? If you are currently receiving support for any mental health/wellbeing conditions please provide a brief outline of the support you're receiving here.

Are there any specific anxieties, concerns or feelings you are experiencing at the moment?

Is there anything else you'd like to share with us?

By completing and submitting this questionnaire you are giving permission for The Milk Hub & Parenting Explorers to collect and process the above information including any personal information as defined under GDPR regulations, and in line with both our legitimate interests. All information you supply is held in the strictest confidence and not shared with other third parties without your consent. The only exception is where we have a legitimate safeguarding concern for the wellbeing of you and/or your children, when we are duty bound to pass on information to the relevant agencies. Completing and submitting this questionnaire also acknowledges that you accept the Privacy Notice and Terms and Conditions listed on the website The Milk Hub.

I agree

By completing and submitting this questionnaire you agree to be responsible and supervise your child/children at all times throughout the Beyond Birth sessions. *

I agree

Beyond Birth Questionnaire

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